Createch Order Form - Bar

TITANIUM BARS
ORDER FORM
CASE INFORMATION
DOCTOR:
PATIENT NAME | CODE:
LAB:
CUSTOMER NUMBER:
DOLDER®
BAR
CREATECH
BAR
LOCATOR®
BAR
PRECI-VERTIX®
BAR
BAR PROFILES
®
®
CREATECH
®
PRECI-HORIX
LOCATOR
PRECI-VERTIX
®
DOLDER Y
MICRO
MACRO
®
DOLDER U
®
HADER
MICRO
ACKERMANN
OTHERS:
MACRO
OPTIONS
GOLD SHADED
IMPLANT SYSTEM
YES
NO
IMPLANT-LEVEL
TYPE
PLATFORM
IMPLANT POSITION
NC
BONE LEVEL
RC
NN Ø 3,5
NNC Ø 3,5
SOFT TISSUE LEVEL
RN Ø 4,8
WN Ø 6,5
Ø 3,5
ABUTMENT-LEVEL
Ø 4,5
MULTI-BASE ABUTMENT
Ø 6,5
ANGLED ABUTMENT
Ø 3,5
SCREW-RETAINED ABUTMENT
Ø 4,6
RN Ø 4,8
SYNOCTA® 1.5 ABUTMENT
WN Ø 6,5
OTHER STRAUMANN PLATFORM
THE CREATECH RESTORATION IS DELIVERED WITH THE APPROPRIATE AMOUNT OF SCREWS.
WOULD YOU LIKE ADDITIONAL PROSTHETIC COMPONENTS?
IF YES, SELECT:
ATTACHMENT
ADDITIONAL NOTES:
DATE:
*
SIGNATURE:
I hereby confirm that the information given is correct and the model and wax-up are accurate and have been correctly disinfected.
I authorize Createch Medical to design and manufacture the framework based on the impression and order form given.
CREATECH MEDICAL S.L.
Polígono Kurutz Gain, P. 3-B
20850 Mendaro (Guipúzcoa)
Spain
T. +34 943 708951
[email protected]
www.createchmedical.com
PREPARATION OF
THE MASTER MODEL
FOR A CORRECT PROCESSING OF YOU CASE, PLEASE PROVIDE A MASTER MODEL WITH THE FOLLOWING:
• NEW ORIGINAL ANALOGS THAT DO NOT MOVE IN THE MODEL.
- DAMAGED, MOVING AND COPYCAT ANALOGS WILL RESULT IN POOR FIT OF THE FRAMEWORK.
• A REMOVABLE SOFT TISSUE IN ONE PIECE.
• FINAL WAX UP FIXED TO THE MODEL IN AT LEAST 2 POSITIONS.
*
ALWAYS USE NEW, GENUINE STRAUMANN® ANALOGS
DO NOT USE DAMAGED OR SCRATCHED ANALOGS
NO MOVING ANALOGS
REMOVABLE SOFT TISSUE MASK
Should the model not fulfill the requested conditions, Createch Medical reserves the right to return the case for the its modification
to the requested conditions.
CREATECH MEDICAL S.L.
Polígono Kurutz Gain, P. 3-B
20850 Mendaro (Guipúzcoa)
Spain
T. +34 943 708951
[email protected]
www.createchmedical.com